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What's the difference? Cancer surgeries

November 21, 2017 | by CTCA

cancer surgeries
While many surgeries are designed to remove as much cancer as possible, some procedures have other goals—and those that are appropriate for some patients may not work the same on others with the same cancer type.

Many cancer patients are faced with the prospect of surgery, but the type of procedure performed varies widely in scope, intent, outcome and other factors. While many surgeries are designed to remove as much cancer as possible, some procedures have other goals—and those that are appropriate for some patients may not work the same on others with the same cancer type. "Most people want what would be considered a curative surgery," says Diego Muilenburg, MD, Surgical Oncologist at our hospital near Phoenix. "But it's not a cookie cutter. You have to tailor what you do to the patient. A cancer often has distinct characteristics, with its own unique biology, its own unique DNA. And while there are a lot of similarities, no two cancers are the same, and they respond differently and have different outcomes."

A cancer often has distinct characteristics, with its own unique biology, its own unique DNA. And while there are a lot of similarities, no two cancers are the same, and they respond differently and have different outcomes.” - Diego Muilenburg, MD, Surgical Oncologist

 

The differences in cancer surgeries range from removing tumors for diagnosis and staging, to removing just enough to improve a patient's quality of life. Below are some examples of surgeries that are commonly performed on cancer patients, and why.

Diagnostic and staging procedures

A biopsy is a surgical procedure designed to diagnose a tumor’s type and stage. The operation may range from an outpatient procedure performed with a small needle that captures a sample of a tumor, to a major procedure that requires anesthesia and stitches. Biopsies may be performed during other types of surgery and as part of an initial diagnosis, or to help gauge the progression of the disease. In some cases, lymph nodes and organs around the cancer may be biopsied so they can be examined to determine the extent of the disease and whether it has spread.

Primary or curative surgeries

"The goal here is to leave the patient with no evidence of disease," says Derrick Beech, MD, FACS, Surgical Oncologist and Chair of Surgery at our hospital near Phoenix. This surgery may be performed when cancer is found in only one part of the body and no evidence suggests it has spread locally or metastasized. Patients with stage I colorectal cancer, for instance, may undergo a primary surgery that removes all evidence of disease and requires no further treatments. In some cases, surgery may be performed before or after other treatments like chemotherapy or radiation therapy.

Prophylactic or preventive procedures

Some patients opt for surgery even if they don't have cancer, because they have a family history of the disease or carry a gene mutation that raises their cancer risk. For example, women with an inherited mutation in their BRCA1 or BRCA2 genes are at a higher risk of breast and ovarian cancers. They may choose to have a prophylactic mastectomy and/or have their ovaries removed to reduce their cancer risk. "It can be a very difficult decision for some people," says Melanie Corbman, MS, LCGC, Licensed Certified Genetic Counselor at our hospital in Philadelphia. "In some cases, I've recommended counseling to help them make a decision. Some people may not be ready to make that decision, so I suggest they start with screening and see what works for them. There are options."

Cytoreductive or debulking surgeries

These procedures are intended to reduce the size of a tumor or remove visible masses from an area, often prior to another treatment, such as radiation therapy or chemotherapy. This type of surgery may be performed just prior to hyperthermic intraperitoneal chemotherapy (HIPEC), a treatment—typically for advanced colorectal, ovarian or appendix cancer—in which a surgical oncologist delivers a heated chemotherapy solution directly to the abdomen after removing multiple tumors from the area.

Palliative procedures

As with any type of palliative care, the goal of these surgeries is to relieve discomfort and improve quality of life. For example, surgery may be performed to remove a blockage in the colon or an obstruction in the lungs.

Reconstructive or restorative surgeries

As its name suggests, reconstructive surgery is intended to rebuild or restore a part of the body that has been disfigured by surgery. These procedures are especially common after surgery to remove breast or head and neck cancers.

Supportive procedures

These surgeries are performed to insert catheters, ports or devices that allow patients to receive medication directly into the bloodstream rather than having to receive repeated injections.